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Screening for breast cancer with mammography, either alone or in combination with physical examination, aims at lowering the mortality in the disease. The outcome of interest in evaluating screening programs is therefore mortality in breast cancer.
Survival analyses based on screening evaluations are notoriously difficult to interpret. Lead time bias, length bias sampling, and potential overdiagnosis threaten the validity in comparisons between screened and unscreened women.[1] Even if length bias sampling, and overdiagnosis, which pertain largely to the first screening round, are thought to be relatively minor problems,[2] lead time bias still presents a ...